Vol 19, No 12 (2017)


A review of the new clinical guidelines of the European Cardiological Society in 2017 on the use of double antiplatelet therapy

Erlikh A.D.


This material is the most important excerpt from the clinical guidelines of the European Cardiological Society (ECS) in 2017 on the use of double antiplatelet therapy (DAT). Developed on the basis of several dozens of clinical studies, the management of the ECS indicate which DAT drugs should be used and in what cases, for how long and in what patients should DAT be prescribed. In addition, separate sections of the document are devoted to the rules of using DAT in patients undergoing scheduled surgical intervention, as well as in patients who need oral anticoagulants. The latest clinical guidelines on DAT are the most important practical tool for the qualitative work of cardiologists, and will also be useful to doctors of other specialties.
Consilium Medicum. 2017;19(12):8-11
pages 8-11 views

Clinical studies of rosuvastatin from the GALAXY project in the context of the new EAS/ESC-2016 recommendations on dyslipidemia Part 1

Susekov A.V.


Hypercholesterolemia is the most important risk factor for the development and progression of atherosclerosis in almost all populations, including the Russian Federation. Inhibitors of HMG-CoA reductase (statins) - the most well-known and well-studied class of lipid-lowering drugs with a convincing evidence base for reducing the risk of cardiovascular and total mortality. Rosuvastatin (Crestor®) - statin of the 4th generation, used in daily doses of 5-40 mg, has maximal activity in inhibiting HMG-CoA reductase and, accordingly, lowering the level of low-density lipoprotein cholesterol, has been well studied in the clinical studies program GALAXY in the period 2004-2011 In 2016, the European Society for the Study of Atherosclerosis and the European Society of Cardiology (EAS/ESC) on the diagnosis and treatment of dyslipidemias published a regular recommendation, in which statin therapy in patients with high cardiovascular risk is a priority (evidence of IA). This article discusses the role of classical studies of rosuvastatin from the GALAXY project in the light of the recommendations on dyslipidemia in 2016, as well as the current strategy of treatment with HMG-CoA reductase inhibitors in primary prevention patients with type 2 diabetes mellitus, patients with carotid arteriosclerosis, and platelet stabilization issues are discussed on the background of intensive therapy with statins.
Consilium Medicum. 2017;19(12):12-19
pages 12-19 views

General principles and guidelines for the management and treatment of patients with gout on the basis of updated European recommendations

Tsurko V.V., Gromova M.A.


In 2016, updated European general principles and guidelines for managing patients with gout are published. The emphasis is on pharmacological/non-pharmacological methods of treatment and on urasnizhayuschee therapy in patients with impaired renal function. For the first time in Russia, along with allopurinol, a drug with a uracminating effect is recommended - febuxostat. The purpose of this review is to inform doctors about the mandatory achievement of a target uric acid level in the treatment of gout with hyperuricemia.
Consilium Medicum. 2017;19(12):20-24
pages 20-24 views

Major principles of angina diagnostics and differential diagnostics

Vasilev A.P., Streltsova N.N.


Conception of major principles in diagnostics and differential diagnostics of angina was proposed according to the authors` clinical practice and modern notions. The structure, sequence and mechanism of medical diagnostic search are observed in the study. Principles and approaches to solving differential diagnostics problems are performed from up-to-date attitude.
Consilium Medicum. 2017;19(12):26-31
pages 26-31 views

The role of antagonists of mineralocorticoid receptors in the pharmacotherapy of chronic heart failure

Batishcheva G.A., Mubarakshina O.A., Somova M.N., Dronova Y.M.


A representative of the antagonists of mineralocorticoid receptors, eplerenone, demonstrates high efficacy and safety in the complex treatment of patients with chronic heart failure. The drug affects the pathogenesis of this condition, improving the prognosis of patients. The efficacy and good tolerability confirmed in clinical trials allow the use of Espiro's eplerenone drug in the therapy of cardiac patients to be widely recommended.
Consilium Medicum. 2017;19(12):31-37
pages 31-37 views

Medication for pharmacological cardioversion of paroxysmal atrial fibrillation at the prehospital stage

Loukianova I.Y., Kuzneztov A.V., Komarnitzkiy V.M.


This study demonstrates the effectiveness of procainamide, propafenone and amiodarone for pharmacological cardioversion in patients with paroxysmal atrial fibrillation. The restoration of the sinus rhythm within 60 minutes was observed for propafenone 73.2%, for procainamide 55.00% and for amiodarone 16.13%. of cases.
Consilium Medicum. 2017;19(12):38-41
pages 38-41 views

Correction of late violations of atrioventricular conduction in patients with lower myocardial infarction: the case of ivabradin

Loukianova I.Y., Shishkin A.N.


The study is concerned with the possibility of eliminating late persistent abnormalities of AV-condaction of II-III grades in patients with lower MI through selective blocks of the sinus node automatic activity by ivabradine. The effect of the drug was evaluated with the reference to reduction of automatic activity rate of the sinus node on ECG. Patients were divided into three groups: the 1st group received an inhibitor of ion currents If - ivabradine in a dose of 10 mg/day, in addition to standard therapy; 2nd group received standard therapy; 3rd group received ivabradine in a dose of 15 mg/day, in addition to standard therapy. General characteristics of patients show that steadiness of AV blocks of 2-3 degrees with kept-on function of the sinus node in patients with lower MI is retained by left ventricular heart failure. The results of the observation demonstrate that the restoration of sinus rhythm with AV 1: 1 conduction in patients of all groups occurred with a decrease in the frequency of the automatic activity of the sinus node. The dependence of the outcome of treatment on the dosage of the drug was found by application of logistic regression. Use of the maximum dosage of ivabradine at 15 mg/day provides a faster and uniform decrease in the frequency of automatic activity of the sinus node and elimination of AV abnormalities than dosage of 10 mg/day.
Consilium Medicum. 2017;19(12):42-46
pages 42-46 views

Rational antihypertensive therapy: combined drugs in focus

Zadionchenko V.S., Yalymov A.A., Shekhyan G.G., Shchikota A.M., Ivanova N.A., Terpigorev S.A., Kabanova T.G., Nikishenkov A.M.


The article presents an algorithm for choosing the optimal drug for the treatment of arterial hypertension. The main groups of antihypertensive drugs with the characteristic of the mechanism of their action and possible side effects are described. The authors described in detail the combined antihypertensive drug Triplixam® (Servier Laboratory). The results of multicenter randomized trials of patients with arterial hypertension are presented. On the basis of clinical studies, the high efficacy of Triplixam® in the treatment of arterial hypertension has been proven.
Consilium Medicum. 2017;19(12):47-53
pages 47-53 views

Treatment of systolic arterial hypertension in the elderly: the role of a new blocker of calcium channels of nitrendipine

Syrov A.V.


The prevalence of arterial hypertension is continuously growing, and systolic hypertension plays an important role in patients older than 60 years. The most important position of modern medicine is the direct connection between arterial pressure and cardiovascular morbidity. Recently appeared in Russia, the calcium channel blocker nitrendipine reduces the risk of stroke and dementia in patients with systolic arterial hypertension. The effectiveness of the drug is higher in patients at high risk, in particular, with diabetes mellitus. The use of nitrendipine enhances the practical doctor's ability to perform effective antihypertensive therapy.
Consilium Medicum. 2017;19(12):54-58
pages 54-58 views

Choice of calcium channel blockers in arterial hypertension. Pharmacokinetic and pharmacodynamic mechanisms of high selectivity and superlative action of lercanidipine

Morozova T.E., Vartanova O.A.


The review presents data on the efficacy, pleiotropic effects and safety of a new lercanidipine calcium channel blocker in the treatment of hypertension. This medicine is the high-selective lipophilic blocker of L-channels, duration of action is provided by its slow accumulation in the bilipid cell membranes, that does not cause activating of the sympathoadrenal system. Lercanidipine possesses an organoprotective effect, diminishes the hypertrophy of the left ventricle, improves the kidney function, has anantiproteinuric effect, has a good profile of safety, rarely causes peripheral edema as compared to other dihydropyridines, and is well combined with the intake of other medicines.
Consilium Medicum. 2017;19(12):59-65
pages 59-65 views

The place of rosuvastatin in lipid-lowering therapy in patients with different levels of cardiovascular risk: clinical and pharmacoeconomic efficiency

Sergienko I.V., Rudakova A.V., Karpova E.V.


Rosuvastatin is the latest generation inhibitor of HMG-CoA reductase. Its high efficacy and safety along with small number of interaction with the cytochrome P450 system represent obvious advantages in the therapy of dyslipidemia, one of the main factors in the development of cardiovascular diseases. The purpose of this study was to evaluate the cost-effectiveness of the generic rosuvastatin (Rozart) in patients characterized by various levels of cardiovascular risk. The study was conducted from the perspective of the health care system using the Markov modeling method (10 years). The results of the study demonstrated that the cost-effectiveness of rosuvastatin administered as part of the primary prevention of CAD increases with an increase in the level of cardiovascular risk, while the secondary prevention of CAD is even more cost-effective vs primary prevention.
Consilium Medicum. 2017;19(12):66-73
pages 66-73 views
pages 74-75 views

Multivitamin-mineral supplementation in medical nutrition

Kodentsova V.M., Risnik D.V., Nikitiuk D.B., Tutelyan V.A.


Nutrition of people with the most common diseases at home does not ensure adequate intake of most vitamins and minerals. The most frequent in patients there is a deficiency of vitamin D, B vitamins, carotenoids, in some categories of patients - antioxidant vitamins A and E. The use of reduced and sparing diets on the background of drug therapy leads to further aggravation of vitamin deficiency. According to the Order of the Ministry of Health to improve the vitamin status of patients in a hospital, it is necessary to use vitamin-mineral complexes in a dose of 50-100% of the recommended daily intake. Vitaminization can be carried out by using ready-made forms in the form of tablets, capsules, etc. or by adding industrially prepared premixes of vitamins to ready meals on food units. It is proved that both methods of enriching the diet of patients with physiological doses, i.e. appropriate physiological needs of the organism of vitamins are effective for improving the vitamin status, contribute to the reduction of microsymptoms of vitamin deficiency and are a favorable background for successful treatment. According to the literature, the use of vitamins reduces the length of stay in a medical institution, reduces the cost of treatment and the risk of re-hospitalization.
Consilium Medicum. 2017;19(12):76-83
pages 76-83 views

A verified questionnaire for patients on assessing the availability of potassium, developed by methods of data mining

Gromova O.A., Egorova E.Y., Torshin I.Y., Yudina N.V., Malyavskaya S.I., Limanova O.A.


Based on the analysis of the sample of patients (n=400), a scoring scale was obtained and verified for self-assessment by patients with potassium availability. The total score estimates the potassium levels in the erythrocytes: a larger score on the scale corresponds to a better availability of the patient with potassium. Verification of the scale in the control sample of patients (n=200) showed a reliable correlation between scores and experimentally determined potassium levels in red blood cells, so that each scale score corresponds to +1 mmol/L potassium in erythrocytes. The scale allows for rapid assessment of the supply of potassium to the body.
Consilium Medicum. 2017;19(12):84-90
pages 84-90 views

The use of a-lipoic acid in ischemic stroke associated with diabetes mellitus

Shurdumova M.H.


The review presents current information on the molecular mechanisms of the neuroprotective and neuroproliferative effects of a-lipoic acid. The data of domestic and foreign studies on the efficacy and safety of the use of a-lipoic acid as a neuroprotector in ischemic stroke are presented, including in patients with diabetes mellitus.
Consilium Medicum. 2017;19(12):91-93
pages 91-93 views

Side effects of non-steroidal anti-inflammatory drugs

Dyadyk A.I., Kugler T.E.


The side effects of drugs, including renal and cardiovascular complications, are a topical medical problem throughout the world. The leading place in their development is occupied by non-steroidal anti-inflammatory drugs (NSAIDs), which are the most frequently prescribed classes of drugs. The mechanism of action of NSAIDs is associated with the block of synthesis of vasodilator renal prostaglandins due to inactivation of the cyclooxygenase enzyme. This can lead to the development of vasomotor nephropathy, acute tubulointerstitial nephritis, chronic kidney disease and other renal side effects. In patients with hypertension, NSAIDs can lead to both a significant increase in blood pressure and a change in the pharmacokinetics of the antihypertensive drugs. Therefore, the appointment of NSAIDs should be strictly regulated, health workers should use minimally effective doses and duration of use; need competencies in cardiovascular and renal risk factors assessment.
Consilium Medicum. 2017;19(12):94-99
pages 94-99 views

Clinical polymorphism of RASopathies in terms of the children's cardiology department

Melnik O.V., Gudkova A.Y., Vershinina T.L., Nikitina I.L., Kostareva A.A., Pervunina T.M.


The article presents 7 clinical cases of RASopathies, including 2 fatal, which has manifested by hypertrophic cardiomyopathy of varying severity (n=6) and noncompaction myocardium (n=1) in pre- and postnatal periods observed in the V.A.Almazov NMRC. Cardiomyopathy was the dominant symptom in all cases. LEOPARD syndrome was diagnosed in 2 patients clinically, facial dysmorphism were also in two patients. Execution targeted sequencing of the new generation on the target panel 108 genes associated with the development of congenital diseases of the myocardium, cardiomyopathies, and kanalopathy, followed by sequencing by Sanger, allowed to detect various mutations in the genes PTPN11, BRAF, CBL in patients.
Consilium Medicum. 2017;19(12):100-104
pages 100-104 views

Current aspects of glycemic control in young children with diabetes mellitus

Vitebskaya A.V.


Due to growth of prevalence of diabetes mellitus type 1 (DM 1) among young children new ISPAD (International Society for Pediatric and Adolescent Diabetes) Consensus on Managing diabetes in preschool children was developed. Glycosylated hemoglobin A1c level for preschool children is recommended to keep below 7.5%. Basic causes of non-reaching of glycemic goals are considered unpredictability of meals and physical activity in young children, fear of parents in front of hypoglycemia, glycemic variability. Reaching the goals is supported by positive attitude to self-control procedures, education of patients’ relatives taking into account the age of a child, precise glycemic control from the first months of disease. For satisfactory glycemic control it is recommended to measure glycaemia 7-10 times per day; to use only the most precise glucometers; to teach patient family members correct exploitation of glucometer. Grownups should encourage self-dependence of a child, but all of such manipulations should be controlled by grownups. In the article own data are given - results of 30 patients questionnaire on glycosylated hemoglobin level, age when they stated to use glucometer themselves, frequency of glycaemia measurements.
Consilium Medicum. 2017;19(12):106-108
pages 106-108 views

Val30Met-transthyrethin amyloid polyneuropathy and cardiomyopathy (review of literature and case report)

Gudkova A.Y., Amelin A.V., Krutikov A.N., Poliakova A.A., Safyanova N.V., Shavlovskiy M.M., Khmelnitskaya K.A., Korzhevsky D.E., Semernin E.N.


An overview of the literature on the problem of Val30Met-ATTR is presented. The clinical course of the late debut of Val30Met-TTR amyloid polyneuropathy and cardiomyopathy is described. Neuropathic and cardiomyopathic "masks" of transthyretin amyloidosis have been analyzed. Algorithms of diagnostics and bases of modern medical tactics for transthyretin (mt) amyloidosis are given.
Consilium Medicum. 2017;19(12):109-116
pages 109-116 views

Yes to a new class of drugs

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Consilium Medicum. 2017;19(12):117-118
pages 117-118 views

Daily changes in urine flow in patients with prostatic adenoma and a neurogenic bladder in the context of conservative therapy

Danilov V.V., Ostobunaev V.V., Danilov V.V., Borshchenko S.A., Besedin S.V., Danilov V.V.


We observed a group of patients from 15 patients (mean age 69 years) undergoing a course of conservative therapy in connection with prostate adenoma. After the examination, conservative therapy was prescribed, including a1-adrenoblockers, vascular therapy agents, nootropics and vitamins. For evaluation of the functional state of the lower urinary tract, a two-day home uroflower monitoring was used. In the process of therapy, it was possible to fix the restoration of previously lowered urine streams in the night and pre-morning hours. According to the neurophysiological model of the pathogenesis of urination disorders in patients with prostate adenoma, the appointment of a1-adrenoblockers has an effect on the control structures of the central nervous system, so it is also advisable to administer nootropics, vitamins and vascular therapy.
Consilium Medicum. 2017;19(12):119-122
pages 119-122 views

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